Shoulder Injuries in Swimmers and Surfers: Causes and Treatment

By Robert Brown, APA Sports and Exercise Physiotherapist | Salty Sports Physiotherapy, Kingscliff

Living on the Tweed Coast means being surrounded by people who love the water. Whether you're paddling out at Casuarina, clocking laps at the local pool, or training for your next ocean swim, your shoulders are working incredibly hard every single session. And for many swimmers and surfers, it's only a matter of time before that hard work catches up with them.

Shoulder injuries are the most common overuse injury in both swimming and surfing. The good news is that with the right assessment and treatment, most shoulder problems respond really well to physiotherapy and you can get back in the water sooner than you might think.

Here's what you need to know.

Why Are Swimmers and Surfers So Prone to Shoulder Injuries?

The shoulder is the most mobile joint in the human body, which is exactly what makes it so vulnerable to injury. It relies heavily on the surrounding muscles, particularly the rotator cuff, to keep it stable and moving efficiently. When those muscles are overworked, fatigued, or not functioning well together, things start to break down.

Consider this: a recreational swimmer completing a 2km session will perform somewhere between 1,500 and 2,000 shoulder rotations. A competitive swimmer training twice a day can easily exceed 10,000 strokes per session. And for surfers, paddling out through surf, catching waves, and repeating that process over a two-hour session places enormous repetitive load on the shoulder.

It's not a matter of if the shoulder will get tired, it's a matter of whether it's strong and resilient enough to handle that load day after day.

The Most Common Shoulder Injuries in Swimmers and Surfers

Rotator Cuff Tendinopathy

The rotator cuff is a group of four muscles that surround and stabilise the shoulder joint. In swimmers and surfers, these tendons are under constant repetitive load and can become irritated and painful over time, a condition called tendinopathy.

It typically feels like a dull ache deep in the shoulder, often worse when lifting the arm overhead or reaching across the body. It can also be uncomfortable at night, particularly when lying on the affected side.

Shoulder Impingement Syndrome

Impingement occurs when the tendons of the rotator cuff are pinched or compressed as they pass through the narrow space beneath the shoulder blade. It's extremely common in swimmers and surfers and often develops gradually over weeks or months of increased training load.

The most common symptom is a sharp or aching pain when lifting the arm to the side or overhead, sometimes described as a painful arc between about 60 and 120 degrees of arm elevation.

Shoulder Instability

Some swimmers and surfers, particularly those who are naturally flexible, develop shoulder instability over time. The shoulder feels loose, unstable, or like it might slip out of place, particularly during the catch phase of freestyle or when paddling through heavy surf. This is less about a specific structure being damaged and more about the muscles not providing enough dynamic control of the joint.

Labral Tears

The labrum is a ring of cartilage that deepens the shoulder socket and helps keep the ball of the joint in place. In surfers particularly, a fall, a wipeout, or a sudden forceful movement can cause a labral tear. Symptoms include a deep aching pain, clicking or catching in the shoulder, and a feeling of instability.

Swimmer's Shoulder vs Surfer's Shoulder: Is There a Difference?

While the structures involved are often the same, the mechanism of injury is slightly different between the two sports and it's worth understanding why.

In swimming, the injury is almost always a pure overuse problem driven by stroke volume, technique faults, or a sudden increase in training load. Freestyle is the biggest culprit, particularly the internal rotation that occurs during the underwater pull phase combined with the reaching motion of the catch.

In surfing, the demands are more varied. Paddling is the primary driver of overuse injuries, but surfers also deal with acute injuries from wipeouts, falls, and the sudden dynamic loads that come with riding waves. Pop-up technique can also contribute, particularly if there's a lot of load going through one shoulder repeatedly.

What Causes These Injuries to Develop?

In my experience, most shoulder injuries in swimmers and surfers come down to a combination of these factors.

Training load is the most common culprit. A sudden increase in session frequency, distance, or intensity without giving the body time to adapt is the fastest way to develop an overuse injury. This is particularly common at the start of a new season or in the lead-up to a big event or competition.

Technique faults in swimming, particularly a dropped elbow during the catch, crossing over the midline during entry, or poor body rotation, significantly increase the load on the rotator cuff. Even small technical inefficiencies become significant problems when

multiplied across thousands of strokes.

Muscle weakness or imbalance, particularly of the rotator cuff and the muscles around the shoulder blade, means the shoulder has to work harder to stay stable during every stroke or paddle. Over time this leads to fatigue and eventually injury.

Poor shoulder blade control is often overlooked but critically important. The shoulder blade needs to move and rotate efficiently to create space for the rotator cuff tendons as the arm is raised overhead. When it doesn't, impingement and tendon irritation follow.

How Are These Injuries Treated?

The approach to treatment depends on the specific injury, how long it's been present, and what's driving it. But here's a general overview of what rehabilitation looks like for most swimmers and surfers with shoulder pain.

The first step is always an accurate diagnosis. Understanding exactly which structure is involved and why it's been injured is the foundation of effective treatment. This involves a thorough assessment of shoulder movement, strength, stability, and control, as well as a discussion about training load, technique, and history.

Once we have a clear picture, treatment typically involves hands-on physiotherapy to reduce pain and restore movement, a targeted strengthening program for the rotator cuff and shoulder blade muscles, load management to allow the irritated tissue to settle while keeping you as active as possible, and technique review where relevant.

The goal is never just to get you pain free. It's to make sure the shoulder is strong, stable, and resilient enough to handle the demands of your sport long-term.

When Should You See a Physio?

The short answer is sooner rather than later. Shoulder problems that are ignored or pushed through have a habit of becoming more complex and taking longer to resolve. If you've had shoulder pain for more than a week or two, or if it's affecting your training, your stroke, or your ability to paddle, it's time to get it properly assessed.

At Salty Sports Physiotherapy in Kingscliff, we work with swimmers and surfers of all levels, from local club swimmers and weekend surfers to competitive ocean swimmers and experienced surfers who've been riding these breaks for decades. We understand the demands of water sport and we'll help you get back in the water as quickly and safely as possible.

Book online at saltysportsphysio.com.au or call 0470 434 340. We're located inside Salt Movement and Recovery, Basement, 2 Bells Blvd, Salt Village, Kingscliff. Just a short drive from the beach.

Salty Sports Physiotherapy is located at Basement, 2 Bells Blvd, Salt Village, Kingscliff NSW 2487. Robert Brown is an APA Sports and Exercise Physiotherapist with over 20 years of elite sport experience. Online bookings available at saltysportsphysio.com.au